Lung volume reduction surgery

Lung volume reduction surgery (LVRS) is a surgical procedure that removes damaged lung tissue in patients with severe emphysema in order to improve the function of the remaining lung tissue. Up to 30 percent of the diseased lung tissue is removed from each lung thereby increasing lung capacity and improving breathing ability of the patient. Emphysema is a type of chronic obstructive pulmonary disease (COPD). Emphysema occurs as a result of destroyed air sacs making it increasingly hard to breathe.

Who is a candidate?

A comprehensive study, the National Emphysema Treatment Trial (NETT), which was conducted from 1998-2002, concluded that patients with severe emphysema of the upper lobes with decreased exercise capacity benefit the most from LVRS (see Group 1 below). Each patient’s exercise capacity and ability to tolerate surgery also influences the effectiveness of LVRS.

The NETT study identified four groups and the results of LVRS for each group:

Group 1 – Participants who predominantly had upper lobe emphysema and decreased exercise capacity were more likely to have longer life spans and apt to function better after LVRS than after medical treatment alone.Group 2 – Participants who predominantly had upper lobe emphysema and high exercise capacity were also increasingly apt to function better after LVRS than after medical treatment that did not include surgery. There was no reported difference in life span between those who underwent LVRS and those who received non-surgical medical treatment.Group 3 – Participants with primarily non-upper lobe emphysema and low exercise capacity experienced less shortness of breath after LVRS than non-surgical medical treatment. Life span and exercise ability were similar for both groups – those that had LVRS and those who opted for non-surgical medical treatment.Group 4 – Lower survivor rates were found for participants with non-upper lobe emphysema and high exercise capacity who underwent LVRS rather than medical treatment. The likelihood of improved functioning was similarly low for both LVRS and medical treatment participants.

Physicians at University of Kentucky Medical Center are highly skilled at determining who meets the established criteria for LVRS.

Risks

• Air leakage (approximately 40 percent of patients have this problem)• Pneumonia ( 15 percent - especially problematic for patients who were prone to recurrent bouts before surgery)• Stroke (less than one percent)• Bleeding (three to five percent)• Heart Attack (one percent)

The procedure

There are two ways to perform the surgery – sternotomy and thoracoscopy. A sternotomy is an invasive approach that requires cutting through the breastbone to open the chest and remove damaged lung areas at once. A thoracoscopy is a minimally invasive approach that requires three to five small incisions on each side of the chest. A videoscope is inserted on one side allowing the surgeon to visualize the inside of the chest cavity and the instruments are inserted in the incisions on the other side of the chest. This method can be completed on one side or both sides at once.